You have ringing in your ears. You had your hearing tested, and the result came back normal. So where is the ringing coming from?
The short answer is that a standard hearing test does not look everywhere. It measures the quietest sounds you can hear at a set of pitches from 250 to 8000 Hz. That range covers most of the sounds in speech, which is why it became the standard. Your ears hear up to about 16,000 to 20,000 Hz, and the parts of the inner ear that handle those higher pitches are often the first to be damaged by noise and age.
When we test people with tinnitus beyond 8000 Hz, we regularly find hearing loss that the standard test never measured. We have seen people with a “normal” audiogram and a clear loss from 11,000 to 16,000 Hz, and people whose tinnitus pitch sat at 11,200 Hz, well above the top of a standard test.
Why hidden hearing loss can cause tinnitus
The most widely accepted explanation for most tinnitus is that the brain turns up its own volume when it receives less sound from the ear. If a patch of the inner ear stops sending signals, the parts of the brain that listen to that patch become more sensitive, trying to make up for what is missing. That extra sensitivity can sound like ringing, hissing, or buzzing.
That process does not need a loss large enough to show up in the speech range. A small area of damage above 8000 Hz can be enough, and it helps explain why tinnitus pitch is so often high.
The tests that find it
Extended high-frequency audiometry. The same headphone test, carried on from 8000 Hz up to 16,000 Hz. It takes a few extra minutes and often explains a tinnitus that a standard test could not.
Otoacoustic emissions (OAEs). A healthy inner ear produces tiny sounds of its own in response to sound. A probe in the ear canal picks them up. When the outer hair cells are damaged, those responses weaken or disappear. We test OAEs from 2000 to 10,000 Hz. Because the test does not rely on you pressing a button, it can show early damage even when your hearing thresholds are still within normal limits.
Speech in noise. Many people with early damage can hear speech well in quiet and struggle in a busy restaurant. A speech-in-noise test measures that directly.
Together, these tests often turn “we can’t find anything” into a clear explanation, and a clear explanation is one of the most effective things you can have when living with tinnitus. People worry less about something they understand.
Does it matter if we find something?
Yes, for three reasons.
- It points to the cause. A pattern of high-frequency damage usually means noise exposure, age-related change or both. That shapes what you do next, including how you protect your hearing.
- It guides treatment. Knowing the pitch and pattern of your hearing loss helps us choose sounds for sound therapy, and tells us whether hearing aids might help later.
- It gives you a baseline. If your tinnitus changes, a repeat test shows whether your hearing has changed too. Noticing tinnitus more does not by itself mean your ears have got worse, and a baseline lets us check.
When the tests really are normal
Some people have tinnitus and normal results on every test. That still tells us something useful. It rules out the most common ear causes and moves attention to other factors we know can drive tinnitus, such as jaw clenching, neck tension, stress and poor sleep.
When to see a doctor first
See your GP promptly if your tinnitus is in one ear only and new, beats in time with your pulse, or came with a sudden drop in hearing, dizziness or facial weakness. A sudden drop in hearing needs a doctor the same day.
Book a tinnitus assessment
Our tinnitus assessment includes extended high-frequency testing to 16,000 Hz, OAEs, speech testing in noise and tinnitus matching as standard. Bring any previous hearing tests so we can compare.
